American Health Care Essay, Research Paper

The American Health Care system has prided itself on providing high

quality services to the citizens who normally cannot afford them. This

system has been in place for years and until now it did a fairly decent

job. The problem today is money; the cost of hospital services and

doctor fees are rising faster than ever before. The government has

been trying to come up with a new plan these past few years even though

there has been strong opposition against a new Health Care system.

There are many reasons why it should be changed and there are many

reasons why it shouldn’t be changed. The main thing that both sides

heads towards is money. Both sides want to save money just in

different ways.

The movement for changing the Health Care system believes that there

is a need for change because of the problems that the system faces

today cannot be handled. Every month, 2 million Americans lose their

insurance. One out of four, 63 million Americans, will lose their

health insurance coverage for some period during the next two years .

37 million Americans have no insurance and another 22 million have

inadequate coverage . Losing or changing a job often means losing

insurance. Becoming ill or living with a chronic medical condition can

mean losing insurance coverage or not being able to obtain it. Long-

term care coverage is inadequate. Many elderly and disabled Americans

enter nursing homes and other institutions when they would prefer to

remain at home. Families exhaust their savings trying to provide for

disabled relatives. Many Americans in inner cities and rural areas do

not have access to quality care, due to poor distribution of doctors,

nurses, hospitals, clinics and support services. Public health

services are not well integrated and coordinated with the personal care

delivery system. Many serious health problems — such as lead

poisoning and drug-resistant tuberculosis — are handled inefficiently

or not at all, and thus potentially threaten the health of the entire

population. Rising health costs mean lower wages, higher prices for

goods and services, and higher taxes. The average worker today would

be earning at least $1,000 more a year if health insurance costs had

not risen faster than wages over the previous 15 years . If the cost

of health care continues at the current pace, wages will be held down

by an additional $650 by the year 2000. More and more Americans have

had to give up insurance altogether because the premiums have become

prohibitively expensive. Many small firms either cannot afford

insurance at all in the current system, or have had to cut benefits or

profits in order to provide insurance to their employees. Those

problems are just with the system, the main part of the problem comes

from the insurance agencies. Quality care means promoting good health.

Yet, the agencies waits until people are sick before they starts to

work. The agencies are biased towards specialty care and gives

inadequate attentions to cost-effective primary and preventive care.

Consumers cannot compare doctors and hospitals because reliable quality

information is not available to them. Health care providers often

don’t have enough information on which treatments work best and are

most cost-effective. Health care treatment patterns vary widely

without detectable effects on health status. Some insurers now compete

to insure the healthy and avoid the sick by determining “insurability

profiles” while they should compete on quality, value, and service.

The average doctor’s office spends 80 hours a month pushing paper.

Nurses often have to fill out as many as 19 forms to account for one

person’s hospital stay. This is time that could be better spent caring

for patients. Insurance company red tape has created a nightmare for

providers, with mountains of forms and numerous levels of review that

wastes money and does nothing to improve the quality of care. America

has the best doctors who can provide the most advanced treatments in

the world. Yet people often can’t get treated when they need care. The

medical malpractice system does little to promote quality. Fear of

litigation forces providers to practice defensive medicine, ordering

inappropriate tests and procedures to protect against lawsuits. Truly

negligent providers often are not disciplined, and many victims of real

malpractice are not compensated for their injuries. Purchasing

insurance can be overwhelming for consumers. With different levels of

benefits, co-payments, deductibles and a variety of limitations, trying

to compare policies is confusing and objective information on quality

and service is hard for consumers to find. As a result, consumers are

vulnerable to unfair and abusive practices. Insurers have responded to

rising health costs by imposing restriction on what doctors and

hospitals do. A system that was complicated to begin with has become

incomprehensible, even to experts. Each health insurance plan includes

different exclusions and limitations. Even the terms used in health

policies do not have standard definitions. Small business owners, who

cannot afford big benefits departments, have to spend time and money

working through the insurance maze. For firms with fewer than five

workers, 40 percent of health care premiums go to pay administrative

expenses. Administrative costs add to the cost of each hospital stay

with the number of health care administrators increasing four times

faster than the number of doctors. Health claim forms and the related

paperwork are confusing for consumers, and time-consuming to fill out.

Insurance coverage for most Americans is not a matter of choice at all.

In most cases, they are limited to whatever policy their employer

offers. Only 29% of companies with fewer than 500 employees offer any

choice of plans. With a growing number of insurers using exclusions

for pre-existing conditions, arbitrary cancellations and hidden benefit

limitations, consumers have few choices for affordable policies that

provide real protection.

The movement for Health Care reform has created a plan to cover every

American. The plan is called the Health Security plan. The Health

Security plan guarantees comprehensive health benefits for all American

citizens and legal residents, regardless of health or mployment status.

Health coverage is seamless; it continues with no lifetime limits and

without interruption if Americans lose or change jobs, move from one

area of the country to another, become ill or confront a family crisis.

Every American citizen will receive a Health Security Card that

guarantees comprehensive benefits that can never be taken away.

Fundamental principles underlie health care reform, the guarantee of

comprehensive benefits for all Americans, effective steps to

control rising health care costs for consumers, business and the nation,

improvements in the quality of health care, increased choice for

consumers, reductions in paperwork and a simplified system, making

everyone responsible for health care. Americans and their employers

are asked to take responsibility for their health coverage and, in

return, they are guaranteed the security that they will always be

covered under a comprehensive benefit. The Health Security plan

creates incentives for health care providers to compete on the basis of

quality, service and price. It unleashes the power of the market and

puts American consumers in the driver’s seat. Consumers choose from

whom and how they get their care.

The plan empowers each state to set up one or more “health alliances”

that contract with health plans and bargain on behalf of area consumers

and employers. Health plans must meet national standards for coverage,

quality, and service set by the National Health Board. But each state

tailors its approach to local needs and conditions. The Health

Security plan frees the health care system of much of the paperwork and

regulation, allowing doctors, nurses, hospitals and other health

providers to focus on providing high-quality care. It cracks down on

abuse, reforms malpractice law and policy and outlaws insurance

practices that hurt small businesses and imposes the first national

standards for the protection of patient privacy and confidentiality in

medical information and records.

This plan that has been developed by this movement is under serious

scrutiny by the people that don’t want to see a change, mainly

Republicans. Their main argument is that by allowing the states to run

health care insurance agencies will run out of control.. Unfortunately,

reforms have generally relied on increasing government control rather

than expanding market choices. A review of nine states’ reforms

reveals a host of negative consequences: insurance premiums increase;

access to medical care is not improved; jobs are lost; spending on

Medicaid

goes up; insurance companies leave the market; and medical care is

explicitly rationed. The Republicans are completely against state run

health care and are fighting for federal

government health control. The Republican plan allows workers to keep

their health insurance if they leave or lose their job, even if a

worker has a pre- existing condition. Allows the self-

employed to deduct from their taxes 80 percent of their health

insurance premiums . Allows the self-employed and small businesses

with 50 or fewer employees to open tax-free Medical Savings

Accounts to pay for routine medical expenses. In the year 2000, MSAs

will be made available to businesses with more than 50 workers unless

Congress prevents the expansion . Allows tax deductions for long-term

health care, including nursing-home and home-health care. Fights fraud

and abuse in the health care system and reduces burdensome paperwork..

The Republican national health plan that would be funded by the

federal government and administered by the federal government. The plan

would fully cover everyone via a comprehensive public insurance pool,

paid for by taxes from individuals and businesses. The plan has

provisions to limit over-treatment and insufficient care, designed to

both protect patient interests as well as contain costs. Costs would

also be controlled by cutting the current administrative overload and

through health care planning. The plan would not result in an increase

in total health expenditures. The people who are now uninsured will be

insured with funds deriving from massive savings that will occur from

the elimination of the inherent waste in the current system. With more

than 1500 insurance companies and virtually countless payment plans and

policies, our administrative costs have exploded. A single payer system

has a much more basic payment scheme. Doctors would spend less time on

paperwork, and potentially more time with patients. Clinics and

hospitals would need fewer staff members, and would require less costly,

redundant equipment.

The details of the Republican plan are as followed. All essential

care would be incorporated into the plan, including: mental health,

acute care, ambulatory care, long term care and home health care,

prescription drugs and medical supplies, rehabilitation services,

occupational therapy, and preventive medicine. Exclusions would be made

for unnecessary and ineffective procedures. These exclusions would be

determined by expert panels, most probably made of doctors, nurses,

other health care workers, and health planners. Everyone in the U.S.

would receive a national health care plan card, with necessary

identification encoded on it. The card can then be used to gain access

to any fee-for-service practitioner, hospital or clinic. HMO members

can receive non-emergency care through the HMO. As mentioned before, to

implement the national health program, health care costs do not need to

increase. It would however produce a major shift in payment toward

government and away from private insurers and out-of-pocket payments.

Individuals and businesses would pay the same amount for health care,

on average, but the payments would be in the form of taxes. The taxes

contributing to the plan can be found for businesses, for instance, by

adding up the amount spent currently by business for health care. This

would approximately add up to a 9% tax increase for midsize and large

employers . Hospitals and clinics would receive a global sum on a

yearly basis, in addition to allowances for new technology. Funds

would be distributed to physicians and other health care workers in one

of three ways: through fee-for-service arrangements with a simplified

billing schedule, through capitation, paying health care providers on

the basis of how many patients they serve, or through global budgets

established for hospitals and clinics employing salaried health care

professionals.

The debate stands now between letting the states run health care or

continuing control by the federal government. Both make valid points

as to why they are the way to go, but my stance after careful thought

is one of compromise. Let the federal government standardize health

care

while the state governments fund it on a state to state level. With a

national standard to follow prices would be forced to keep the same

through out America. Procedures for problems would not be questioned.

Finally there will be less paperwork. Making the state governments

fund their own health care system at first lance seems to be cost

inefficient. At another look and a explanation I can dispute that.

With the government in total control it had one big pile of money it

had to divide to all the states and no real way to determine how to

divide it. With the individual states involved in funding health care,

they know the size of their population, who needs care in their

population and can do a more efficient job on a smaller scale. Also by

letting the governments on the state level run everything the problem

of the government giving to little to states that need funding and to

much to states that don’t need it

will not occur.

Unfortunately due to the way the government handles major changes

health care reform will most likely be debated for another ten years.

The way the debate is moving it seems to be heading towards the state

controlled health care, but there doesn’t appear to be enough power

behind the movement to get it approved. The dream of universal

coverage s it a dream or is it a near future for all Americans, only

with patience by the people will they find out.